23713 80TH CT W.PDF111111111111
7240
23713 80TH CT W
TAX ACCOUNT/PARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
g.,O% On .'�
CRITICAL AREAS: f-)2 i DETERMINATION: E] Conditional Waiver Study Re ire W
k_/-- C::p I qu ,,<aiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DA
PARKING AGREEMENTS DATED:
EASEMENT(S) RECORDED FOR:
PERMITS (OTHER)
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED: / / --
SEWER LID FEE $:
SHORTPLAT
SIDE SEWER AS BUILT DATED:
SIDE SEWER PERNUT(S)
SOILS REPORT DA
STREET USE / ENCROACHNMNT PERNHT
WATER METER TAP CARD DA
OTHER:
LID
LOT: BLOCK:
j
LATEMP\DST1s\Fomis\Street File Checklist.doc
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1" POLY — 20OPSI
WITH TRACER WIRE @ 2' DEEP
80TH COURT SW
3/4'
copper
CITY OF EDMONDS WATERLINE AS -BUILT
ADDRESS HOMEOWNER
Q), 23713 80TH COURT SW I VIKING PROP.
CONTRACTOR
CAJUN EXC.
DATE DRAWN
7/26/05 BY 1. ABILA
SCALE
NTS
WATERLINE
NO. 2004-1044
PERMIT NO: -9939
City, of Edmonds T EXPIRES bfl,01_1�
i7c. 1%9 SIDE SEWER PERN41T �PERM'
"n
Address of
ID #
Property Tax Account Parcel No.
Attach copies of all access andutility easements' Verified and Approved b
Owner and/.or Con)-ractor-
Contractor Lice , nse #:_Yl
5 Single Family
R,Multi-Family' (No., of Units
R Commercial (No. of Unit's
R Public
Invasion into City *Righ.t-of Way) 10 Yes No
.*RW Construction Permit #
Cross othe ' r "Private Property: El Yes' KNo
"Attach le escription and copy ofrelcorded easement.
9
Owner/Contractor ilk
Owner —or co'ntractdr sigl1fature Ad acknowledgement statement: Date
A I
.,,By si ning for this permit I certify that I have read the:��i y s public handout entitled'
9
ide Sewer Specifications, and shall comply with a1l City requirements outlined therein.
r\
2 CALL DIAL -A -DIG (1-800-42,44-5555) BEFORE ANY EXCAVATION 2
9 FOR INSPECTION CALL 425-771-0220 extension ":31W
24 HOUR NOTICE REOUIRED FOR ALL INSPECTION REQUESTS
FOR OFFICE USE ONLY
Issued By:
Permit Fee $ Repair Fee $
4,01, err
Trunk Charge $ Date Issued:
Assessment Fee $ Receipt No:
City Permit Surcharge Fee A —.11 Total Fees Paid 7-5
NOTE IF JOB SITEIS NOT READY FOR INSPECT.ION WHEN
INSPECTOR ARRIVES A $45 RE -INSPECTION FEE WILL BE CHARGED.
Job.Site Ready YES NO' Date: Ihitial:
Partial Inspection: i)tfd C1 111IM191fiAll? Date: Ali -Initial:
ob� a
Date:
Partial Inspection: Initial:
E C*TION APPROVED: Date: V Initial: As -built to Street"File:
FINAL INSP
13, PERMIT MUST BE POSTED- ON JOB SITE t�
White Copy: File Green.Copy: Inspector'- Buff Copy: Applicant
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CITY OF EDMONDS SIDE SEWER AS- BUILT
ADDRESS 23713 80th Court SW HOMEOWNER
Viking Properties Inc.
CONTRACT'OR SCALE
Viking Properties Inc. NTS
DATE DRAWN PERMIT
6/16/2005 �By Nima M.Moghaddam NO. 9939
0
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221.
The Critical Areas Checklist contained on this form is to
be filled out by any person preparing a Development
Permit Application for the City of Edmonds prior to
histber submittal of the application to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The information
needed to complete the Checklist should be easily
available from observations of the site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
Date Received:-',51 f
City Receipt#:_ 1
Critical Areas File #: --Z CC7-��2--Q
Critical Areas Checklist Fee:-- $45.00
Date Mailed to Applicant: 41—//-03
A property owner, or his/her authorized representative,
must fill out the checklist, sign and date it, and submit it
to the City. The City will review the'checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed copy
of this form to assist City staff in finding and locating the
specific piece of property described on this form. in
addition, the applicant shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, inderrinify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I cer* that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file t Zis plicatiT o e behalf e owner as listed below.
SIGNATURE OF APPLicANT/AG DATE
jo; P
Property Owner's Author' ati I
By my signature, I cer* I C authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
SIGNATURE OF OWNER DATE
Owner/Applicant:
"OW 'W _) /
14ame
Z
Street Address
t�6vOW5
city State zip
Telephone:
Email address (optional):
AppUcant Representative:
Name
1-77, / Rc;6-�tv— 4a-;;-
Street Address
CIT—
city State zip
Telephone: 41 Z 5' - 7-572- - OeV A -
Email Address (optional):
Critical Areas Checklist.doc/3.19.2001
L]
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
The Critical Areas Checklist contained on Us form is to
be filled out by any person preparing a Development
Permit Application for the City of Edmonds prior to
his/her submittal of the application to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The information
needed to complete the Checklist should be easily
available from observations of the site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
Date Received: 1 0--�2
City Receipt#: 110 �-5 0
Critical Areas File #: -7003 1
Critical Areas Checklist Fee: $ 5.00
Date Mailed to Applicant: �Z�13 _ I
A property owner, or his/ber authorized representative,
must fill out the checklist, sign and date it, and submit it
to the City. The City will review the checklist, make a
precursory site visit and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the. Signed copy
of this form to assist City staff in finding and locating the
specific piece of property described on this form. In
addition, the applicant shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, inderrinify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information fumished by the applicant, his/her/its agents or employees.
By my signature, I certify that the inf6rmation and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to ffile, he behal
_�o e �behalf e owner as listed below.
SIGNATURE OF APPLIcANVAGENT DATE t:> /1
Property Owner's Author' ati I! a/
By my signature, I cer* I; Me authorized the above Applicant/Agent to apply for the subject land use application,
and grant my pemmniission for the public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
SIGNATURE OF OWNER
Owner/Applicant:
DATE
PLEASE PRINT CLEARLY , , -j ! . -1
420LA/ MPOMVC
Name
IC3 Z
Street Address
t;6vak/405
city State zip
Telephone: '//0!�>--
Email address (optional):
Applicant Representative:
Name
1-701
Street Address
q7-
city State zip
Telephone: 7-!�-Z -2,E�04-'
Email Address (optional): joht-,P okp-bf -55011,o>,ow,
Critical Arms Checklist.dor)3.191001
9
0
City of Edmonds
Development Services Department
Planning Division
Phone: 425.771.0220
Fax: 425.771.0221
-%;. 107
The Critical Areas Checklist contained on this form is to
be filled out by any person preparing a Development
Permit Application for the City of Edmonds prior to
his/her submittal of the application to the City.
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, or
may be, present on the subject property. The information
needed to complete the Checklist should be easily
available from observations of the site or data available at
City Hall (Critical areas inventories, maps, or soil
surveys).
Date Received: '51 f V I 0�2
City Receipt#: - 1 7-1 up,:�c)
Critical Areas File #: --,1 cc-,�5 - 00z -2-
Critical Areas Checklist Fee: $45.00
Date Mailed to Applicant: �I-eZ3
A property owner, or his/her authorized representative,
must fill out the checklist, sign and date it and submit it
to the City. The City will review the checklist, make a
precursory site visit and make a determination of the
subsequent steps necessary to complete a development
permit application.
Please submit a vicinity map, along with the signed copy
of this form to assist City staff in finding and locating the
specific piece of property described on this form In
addition, the applicant shall include other pertinent
information (e.g. site plan, topography map, etc.) or
studies in conjunction with this Checklist to assistant staff
in completing their preliminary assessment of the site.
The undersigned applicant, and his/her/its heirs, and assigns, in consideration on the processing of the application agrees
to release, indemnify, defend and hold the City of Edmonds harmless from any and all damages, including reasonable
attorney's fees, arising from any action or infraction based in whole or part upon false, misleading, inaccurate or
incomplete information furnished by the applicant, his/her/its agents or employees.
By my signature, I certify that the information and exhibits herewith submitted are true and correct to the best of my
knowledge and that I am authorized to file plication 9p#e beh owner as listed below.
fil
SIGNATURE oF APPLicANT/AG-.- DATE
Property Owner's Author* ati
j: 1;01;
By my signature, I cer* I C authorized the above Applicant/Agent to apply for the subject land use application,
and grant my permission for e public officials and the staff of the City of Edmonds to enter the subject property for the
purposes of inspection and posting attendant to this application.
SIGNATURE OF OWNER DATE
Owner/AppUcant:
"dw I))/
14ame
-Z 1;
Sbvd Address
4;t)wOW5 .
city State zip
Telephone: '?67
Email address (optional):
AppHcant Representative:
Name
1-701
Street Address
crr-
city State zip
Telephone: 7-572-
Email Address (optional):. joh0v I 4Abi
U W
Ctitical Ams Cheddist.doc/3.19.2001
OIL,
Critical Areas Checklist.
--------------- ------------------------------------------------
Site Information (soil s/topography/hydrol ogy/ve getation)
1.
Site Address/Location: 8006' 23d/ __22&�S 4d.
2.
Property Tax Account Number: od 0.2 a - g2
3.
Approximate Site Size (acres or square feet):
4.
Is this site currently developed? _ZYes; _ no.
If yes; how is site developed? Me�,slT� &N AX&*76__rX_
5.
Describe the general site topography. Check all that apply.
F I at: less than 5-feet elevation change over entire site.
AI,IA- Rolling: slopes on site general ly less than 15 % (a vertical rise of I 0-feet over a
horizontal distance of 66-feet).
Hilly: slopes present on site of more than 15% and less than 30% ( a vertical rise of
I 0-feet over a horizontal distance of 3 3 to 66-feet).
Steep: grades of greater than 3 0% present on site �a vertical rise of I 0-feet over a
horizontal distance of less than 33-feet).
Other (please describe):
6.
Site contains a.reas of year-round standing water: AQA1,,--- Approx. Depth-
7.
Site contains areas of seasonal standing water: N
dAIZE_ Approx. Depth:
What season(s) of the year?
8.
Site is in the floodway AZQ floodplain of a water course..
9. Site contains a creek or an area where water flows across the grounds surface? Flows are -year-
round? /DVjVi5'_ — Plows are seasonal? (What time of year9
10. Site is primarily: forested meadow ;shrubs mixed
urban landscaped (lawn,shrubs etc) W1W iAs-� .7v
11. Obvious wetland is present on site: IWA11!5�
--------------------- — -------------- — ---- For City
1-.::: Site is' Zoned! �Is
.2,, SCS mapped soil.type(s)?
:3.
4.
:6.:
Wetlan'd inventory or C.A. map indicates w etland present on site? IM
Critical Arias inventory or C-.A. map indicates Critical Area on site�
:site within designated earth subsidence landslide hazard area?
P. IV
esignated on the'Environmentally Sensitive Areas
Site d Ma
DETERMINATION
QUIRED.
R . P ' d by:
eviewe
fts_chk.doc; Rev 10/0'-
CONDITIONAL WAIVER: -
I Niel
0
City of Edmonds
RECSIVED
J A N 0 6 19909
COMMUNITY SERVICES
CRITICAL AREAS.CHECKLIST
The Critical Areas Checklist contained on this form is
to be filled out by any person preparing a
Development Permit Application for the City of
Edmonds prior to his/her submittal of a development
permit to the City. I
The purpose of the Checklist is to enable City staff to
determine whether any potential Critical Areas are, 'or
may be, present on the subject property. The
information needed to complete the Checklist should
be easily available from -observations of the site or
data available at City Hall (Critical Areas inventories,
maps, or soil surveys).
An applicant, or his/her representative, must fill out
the checklist, sign and date it, and submit it to the
City. The City will review the checklist, make a
precursory site visit, and make a determination of the
subsequent steps necessary to completd-.a,development
permit application.
Please submit a vicinity map along with the signed
copy of this form to assist City staff,in finding and
locating the specific piece of property described on
this form. In addition, the applicant shall include
other pertinent information (e.g., site plan*, -topography
map, etc.) or studie's in conjunction with this Checklist
to assist staff in completing their preliminary
assessment of the site
' . i I
I have completed the attached Critical Areas Checklisit and attest that the answers provided'are factual, to the
best of my knowledg e (fill out the appropriate column below).
Owner/Appl icant:
Toycd A'��a,,V /Vz,,�
Name _/ I .
Street Address
city State Zip
Applicant Representative:
Name
Street Address
city State Zip
Telephone Telephone
S i' naWe
9
D iffle
Signature
Date
Aw 5WIMFJ,37 11,70 ON TMS LOT. ".6
MOS SM W-r rO AF.
ALL EXPOSED SURFAMWTU
COVERED WITHIN 2 DAY,! D
6'xl
D .P '�6 e- l-v
1:4-�5* il
NJ 89'21137" W�' d
% C0:1
<L
17 W "79 i4.83' 0,,
'p,
C,
50'
OWNER/CONTPACl'0qE;b` A-g
)%IB E
FOR EROSION CONTTI- AND DA6 A <
zo
26 if
FAMILY --5 NGI E FAMILY
.8 '-3
C-
RESIDENCE
)ENCE
23713 80th COURT W.
COURT W.
LO
if
MAINTAIN PLAT INSTALLED EPL9SI0j )NTRO-i
19
t-5-
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--9
CR '0
5
.......... q
c' TRACT 00
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2.57' 47. 10'
SD
'00 OCT 20
0 DEVpLop4f 2004
z 04
d". 71-- �7
�11T �ERVIC,�s
CITY L
c 74-61"" "1 917, 7,� J%�- O'F:ED&,ONDS CTF?.
ACCEPTABI E TIGHTLINE
SDR 35 MAT&-ERIAL N
SCH 40 SCALE 1"= C
OWNER/CON TRACTOR N - 12
VIKING PROPERTIES, INC. F810 HANCORw E
P.O. BOX 1034 01 10' 20' 40'
LYNNWOOD, WASHINGTON 98046
PHONE : 425-670-2711 WATER & SEWER PLOT PLAN
INSPECTIONS REQD.
BENCH MARK CALL 425-771-0220 FyT. 1326 FOR
THE PROJECT BENCH MARK IS THE CONCRETE
MONUMENT IN CASE LOCATED AT THE LOT 26, VIKING HEIGHTS
CENTERUNE OF 238TH STREET S.W. AT
APPROXIMATELY THE MIDPOINT OF THE IN SE1/4, SECTION 31, T.27N., R.4E., W.M.
PROPERTY. CITY OF EDMONDS
ELEVATION : 200.00 SNOHOMISH COUNTY, WASHINGTON
DATUM : ASSUMED
APPROVED AS NOTED
BY EbIGINEERINg
11, If III III II Ir F 1 1
Date:
L�ffimg Lovell— Sauerland & Associates, Inc.
�� En&een/Su"eyors/Pla=ers/Development CousWtants
IIIIIIIIIIIIIIIIIS N e-lual ukfo@lsaeugmeeriizg.com - web: Isaeugmeering.omm
IRM 33rd Aveuue T.. Suite 200 LI TA OW - (425)775-1591 (4Z5)6n-7998 tax
BRAIN a== D= FJL
JTT JTT 1 3.6 . 03 - I 1"= 20' 1 YU46?(056-0-04
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LAND W--LMNC Co.
AREAS BETWEEN BUILDINGS-
514ALL BE PLANTED
WGROUND COVER
PER LEGEND (TYP)
— — — — — — — — --
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fit I!Fl
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— — — — — — — — — — — — — — — — —
treWHIGA-BURKHOLDER
if QL14X
ITMIUASSOCIATES, LLC
rft�j LAND liae PLANNING I CIVIL ENGINERRING
1721 Hewitt Avenue a Suite 401 11111 Eveiatt. WA 95201
phono (425)252-29= fox (425)252-9551
174tT 5ZOINO -r PAW OA/ 7#9 LOT -
:h COURT W.
ALL EXPOSED SURFACES TO;/,,
BE COVERED WITHIN 2 LDfi
f%
17" W
50'
§SE#13
OWNER/CONTRACTOR S Ff��PQ S
� c
FOR EROSION CONT40L AND DA)
FAMILY
C14
)ENCE
COURT W.
MAINTAIN PLAT INSTALLED E
......... .
) . -w -24
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NGLE FA
MILY. "C
I AN RESIDENCE
23713 80th 'COURT W.�;-
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IN ?j
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OCT 20
16
2004
ELOP44EN
py I sElivIc"'s
919F
917,75- R I lw'ONDS CTR.
ACCEPTABLE TIGHNNE co iliz
MATERIAL
SDR 35
OWN ER/CON TRACTOR SCH 40 SCALE : 1 =20'
VIKING PROPERTIES, INC. N - 12 W E
P.O. BOX 1034 F81 0 HANCOR 01 10, 20' 40'
LYNNWOOD, WASHINGTON 98046
PHONE : 425-670-2711 WATER & SEWER
INSPECTIONS RE01). PLOT PLAN
BENCH MARK CALL 425-777-0220 Er� 1326 FOR
THE PROJE CT BENCH MARK IS THE CONCRETE
MONUMENT IN CASE LOCATED AT THE LOT 26.. VIKING HEIGHTS
CENTERLINE OF 238TH STREET S.W. AT
APPROXIMATELY THE MIDPOINT OF THE IN SE1/4, SECTION 31, T.27N., R.4E., W.M.
PROPERTY. CITY OF EDMONDS
ELEVATION : 200.00 SNOHOMISH COUNTY, WASHINGTON
DATUM : ASSUMED
APPROVED AS NOTED
BY ENGMINEERI G
Date: f/
VZ&
L �Iffimn Lovell— Sauerland & Associates, Inc.
ragmem/Su-eyors/Planners/Development ConsWtants
�10 0 m-1 - .b: l..Wiebg..
I%W 33rd ivenue T.. Safte 2DO Lynnwood. TA UM - (425)775-1591 (425)672-7998 tax
D JTT I aWjTMT 1 DM36.03 FJL 4656-0-04
LRAYN _ I WAM 20' 1 Mz No
L
1-11-1 K ASSOCIqTES 49(-,2 '746 &60.11
DAILY FIELD REPORT
LJU & ASSOCIA.'FES, INC.
4AO85
J. Liu
i of 1 8
'"rin. Miles
& 26
3:30P
Uwe L�ay 0TWe
4/1812005 Mon.
19213 Kenlak,� Placc INE
Travel Time i reT
Yrm--e—off-!�'�e
3 55P
Weatnei
Part� Cloudy
Kenmoi T, wa,�Iflngton 98028
Photle:(425)481-9134 rax:o,),5)486-2746
Whicle Hrs-079-it—e
F-5 L7,,, auged
1.25
IL,,)ts 25 ',hrouah 26 - Sunrise Ridqe
238th Street 5W., Ednion ds
Client
General CoMraclor Superinteroent
Vikinaca Pr
-- -f operies
Ted Coleman
EarthArork Contractor SuPL.
'Fe—oeived-� �Lck�d IEW
rartiriwoil< Contractor
verify the footing bearing soils for the
At top request by Ted Coleman with Viking Propei ties, I come on site to
houses to be built on the subject lots. At the time of my site visit the footing trenches on these lots have all been
exr,avated out down . to the footing level, No groundwater seepage or standIng water is observed w1min the subieit.L
loi.s. Some loose disturbed soils have falls,-r Into the footing trenches, and in places a thin layer of soils over the
bottorn of the footing benches is disturbed by the scraping of the backhoe bucket, especlalt� the SOLIthern half of
i-ot 26.
The footing trenches are cut dow-n about 2 feet below existing grade into brown to light-browr strUCtUi'al fill 0! silty
fine sand with a trao.e of gravel. A steel T-bar manually pushed into the footing bearing soils can penetrate no more:
than 4 to 5 inches into the undisturbed footing bearing soils, indicat;ng the soils are niedium-dense to dense.
Tho loose thin layer of soils disturbed by backhoe bucket should be conipacted to a non -yielding state with a
Vbrato.ry meonanical compactor It the it)ove reco-lirriendatioris are followed, It, is 11)y opinion that the. footing
bearing soils will be able to render an allowable bearing capacity of at ieasi 3,000 Psf-
coov to: I CA colitill, ' �4: '' " !
on Nco.1,
1) Ted ColemaniViking Propettes 2)
3) 4)
MW
j DATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
ZONE Q�4' ZI;UMBER
�L—
CONSTRUCTION PERMIT APPLICATION
I
JOB S ITE/A
ADDRESS
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LOT NO.
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inspection Required
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METER SIZE
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RESIDENTIAL
PLUMBING MECH
LOT COVERAGe,
ALLOWED PROPOSED
REQUIRED SET13A CKS
FRONT SIDE REAR
SETBACKS (Fr.)
FRONT. UR SIDE REAR
C MPLIANCE OR
0
I
e�-;
a
L!
ADDITION
COMMERCIAL
CHANGE OF USE
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REMODEL
MULTIFAMILY.,
SIGN
PARKING
RE.O'D PROVIDED
' D�AT
LOT A�R ING RrEWED�48YV 3DAT
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GRAQIIJ 0
REPAIR CYOS X FTI
:
A6 ��46M AL.
A
rl DEMOLISH TANK
li�an ag
_R
GARAGE FETAJNINGWA�L FIRE SPRINKLER
CARPORT 1:1 ROCKERY.: 0 FIREALARM
0
(tYPE OF USE, BUSINES4-"CTiVffY)
" I
CHECKE2 By
OPVRUCTION
OCCUPANT
t3
��JTYPE
7
GROUP
NUMBER
NUMBER OF
CRITICAL
OF
oL�,
DWELLING
AREAS
SPECIAL INSP
EA�
OCCUPANT
0
STORIES
UNITS
NUMBER0:3-
_�CTION
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REQUIRE f,1aYES.
LOAD
DESCRIBE WORK TO BE DONE
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REMARKS
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OGRESS INSPECTIONS PERjJBC 108 IBC1091IRC1 09 FINAL IN
VALUATION '1
Nq14 q — C�,4 C)[".�
0 offS/ ? - 6C;Lj�j,_6 I
1 11;�
Diesdription
f - -,F4E E
Description
FEE
q, 1 W/ -
Pla n CheiCk
State Surcharge
SOU�Q
GLAZING %
LOT'SLOPE %
�i r
Ck
�,Building�Pgrmit
CitySurcharge
J11.5
PLWCHECK NO:
�?RlumbiAg--'
Base Fee
,5
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMrT COVERS WORK TO
It
a
13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Z7Y',
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPUCATION: ISO DAYS
PERMIT UMM I YEAR . PROVIDED WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAhM ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
0
2&&_
IN INTEREST, AGREES TO INDEMNIF14 DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER'NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total
Amt. Due
0
xi
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
L
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION
i a2L�
APPROVAL'
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy; and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowiedged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SPWOYJRE (OWNER 0 ENT)
IC7 -,. 4,DAT�
SIGNED
1
(425)
_eFfIg" SIGNATURE X DATE
9/1
/
()q
771-0220
__1
R EA BY fDA
ATTENTION
IT IS UNLAWFULTO USE OR OC4YABUILDING OR STRUCTURE UNTILAFINAL
EXT 1333
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/lRC110.
ORIGINAL - FILE YELLOW - I
PINK -OWNER GOLD -ASSESSOR
09/nn r%r%V-0%0% IlAr%r% %00%81 Ar%l- 11141AW11111,10% A